Genitourinary Tract Infections Research Articles

Abstract 18489: Double Edged Sword: SGLT-2 Inhibitors in the Immunosuppressed Heart Failure Patient

Introduction: SGLT-2 inhibitors are often prescribed for patients with heart failure, as a part of Goal Directed Medical Therapy. There is a known risk of genitourinary tract infections with utilizing this medication class. We present a case of a patient on chronic immunosuppression therapy on Dapagliflozin who developed a prostate abscess. Case Description: 70-year-old male with history of cardiac sarcoidosis on prednisone and mycophenolate mofetil, non-ischemic cardiomyopathy, and atrial fibrillation who initially presented with suprapubic pain and urinary urgency for two weeks. Urinalysis was positive for glucose greater than 1,000 and urine culture positive for Klebsiella pneumoniae. CT imaging revealed a prostate abscess measuring 4.5 x 4.4 x 5.7cm. Patient underwent CT guided drainage of the prostate abscess with thick, purulent drainage that cultured positive for Klebsiella pneumonia. He was initially started on an 8-day course of Ceftriaxone but transitioned to Trimethoprim-Sulfamethoxazole for 6-weeks at discharge. He was previously prescribed Empagliflozin for heart failure, however, this was discontinued due to expense and was switched to Dapagliflozin four months prior to presentation. Discussion: SGLT-2 inhibitors are commonly prescribed in heart failure patients. We encourage special consideration in patients at increased risk of infection, prior to starting SGLT-2 inhibitors as they may have more complicated manifestations of side effects. In this case, the patient underwent procedural interventions and required long term antibiotic therapy as a consequence of SGLT-2 inhibitor use. Conclusion: Patients who are chronically immunosuppressed are at increased risk for infections, including genitourinary, compared to the general population. While trying to optimize patient's cardiomyopathy, it is imperative to consider their risk for developing complications when initiating SGLT-2 inhibitors in immunocompromised patients.

FRI649 ADMIRE: Assessing Dapagliflozin And Metformin As An Initial Regimen In Diabetes Mellitus For Enhanced Glucose Control

Abstract Disclosure: D. Phadke: None. D. Gopal: None. D. Biswas: None. D. Birla: None. A. Prasad: None. P. Joshi: None. Introduction: Early aggressive glucose lowering in type 2 diabetes mellitus (T2DM) has shown improved outcomes, and combination oral antidiabetic agents (OAAs) on top of lifestyle therapy are necessary. In India, most T2DM patients receive combination therapy with two or more OAAs to achieve glycemic targets more rapidly. The fixed dose combination (FDC) of dapagliflozin and metformin is widely used in India, as it improves glycemia, reduces weight and blood pressure (BP), and has good tolerability. This study aimed to evaluate physician practices, efficacy, and tolerability of dapagliflozin and metformin FDC as initial therapy for T2DM patients in a real-world setting. Methods: This multicenter, retrospective, observational study enrolled 481 T2DM patients across 49 clinical units for a period of 6 months. The study aimed to evaluate physician practices, efficacy, and tolerability of dapagliflozin and metformin FDC as the initial choice FDC in T2DM. The study was conducted in compliance with the principles of the Declaration of Helsinki, good clinical practice, and regulatory guidelines. Ethical approval for the study was obtained on August 6, 2022, and the study was conducted from August 15, 2022, to January 20, 2023. Results: The study demonstrated that dapagliflozin and metformin FDC significantly reduced weight by 4.2 kg (p < 0.0001), fasting plasma glucose by 21.4 mg/dL (p < 0.0001), and improved estimated glomerular filtration rate (eGFR) by 1.9 m²/1.73 ml/min (p < 0.0001). Additionally, systolic BP was reduced by 10.7 mmHg (p < 0.0001), and diastolic BP was reduced by 6.6 mmHg (p < 0.0001), which is in combination with the concomitant medications. Incidence of genito-urinary tract infection was 8.9%. Conclusion: In a real-world setting, dapagliflozin and metformin FDC can be used as initial therapy for T2DM with good efficacy, tolerability, and safety. Physicians preferred this combination due to its ability to promote weight loss, reduce cardiovascular events, and decline in renal function. The excellent safety and efficacy reported by physicians for this FDC of dapagliflozin and metformin has contributed to improved compliance with the treatment. Thus, in the Indian population, dapagliflozin and metformin FDC is effective, safe, and has good tolerability as an initial therapy for T2DM. Presentation: Friday, June 16, 2023

A-280 Impact of 2022 CLSI Revised Piperacillin/Tazobactam Clinical Breakpoints on Enterobacterales Isolates Identified at a Tertiary Medical Center in Southern Taiwan

Abstract Background Piperacillin-tazobactam (TZP) is one of the most common antibiotics administered to hospitalized patients. Its broad activity against gram-negative, gram-positive, and anaerobic pathogens. The Clinical and Laboratory Standards Institute (CLSI) publishes revised TZP breakpoints in 2022. The purpose of this study was to evaluate the impact of changing the TZP breakpoint in a regional teaching hospital in southern Taiwan. Methods We retrospectively evaluated TZP for 1347 Enterobacterales isolates identified by MALDI-TOF (Bruker Daltonik, Bremen, Germany) between September 1, 2022, through December 31, 2022, at Chang Gung Memorial Hospital in Chiayi. Blood antimicrobial susceptibility testing was performed using an NMIC-411 panel on the BD Phoenix™ M50. The antibiotic susceptibility test of Enterobacterales from other sources of infection used the Disk diffusion method (Kirby-Bauer Method). Susceptibilities were assessed based on historic CLSI breakpoints in 2021 as well as the current CLSI breakpoints from the most recent CLSI MIC breakpoints, the 32th edition of document M100, published in 2022. Results We evaluated 1347 Enterobacterales isolates. Most isolates identified were Escherichia coli [n = 768 (57%)] and Klebsiella pneumoniae [n = 286(21.2%)]. The new TZP breakpoints reduced the percentage of strains that were previously judged to be susceptible by CLSI M100-S31 from 80.9%(1090/1347) to 50%(674/1347). The majority of isolates 674(50%) were susceptible; 416 (30.9%) isolates were susceptible-dose dependent and 257 (19.1%) were resistant to piperacillin/tazobactam using the new CLSI breakpoints. The results of the analysis of the source of infection found that the bacteria that had the greatest impact on the respiratory tract decreased from 43.6% to 12.7%, followed by the genitourinary tract infection decreased from 80.4% to 27%, bodily fluid infection decreased from 69.8% to 24.5%, and abscesses,wounds,pus decreased from 72.7% to 28.1%; The most insignificant are blood infection strains, from 83.1% to 81.3%. Conclusion Our results indicate an increase in resistance to Enterobacterales isolates tested. Non- susceptible to piperacillin/tazobactam from 19.1% to 50% using the revised CLSI breakpoints. The decreased susceptibilities make it clear that microbiology laboratories should accept new MIC breakpoints. Although our study has demonstrated decreased susceptibilities, there is no correlation with clinical outcomes. In conclusion, changes in breakpoints had a significant impact on the susceptibility of TZP for Enterobacterales isolates in our study. Understanding and evaluating the impact of the breakpoint changes is of paramount importance. Institutions should ensure that their breakpoints are up to date to allow for the most optimized treatment.

Patient and Provider Demographics and the Management of Genitourinary Tract Infections in the Emergency Department.

Urinary tract infections (UTIs) and sexually transmitted infections (STIs) can have overlapping signs, symptoms, and findings on urinalysis. Our objective was to determine if patient or provider demographics are associated with differences in the diagnosis and management of UTIs and STIs in the emergency department (ED). We analyzed 38,062 ED patient encounters from a single healthcare system between April 18, 2014, and March 7, 2017. All encounters were women ≥18 years of age and not admitted to the hospital. We performed logistic regression using patient and provider demographics, laboratory testing results, ED triage data, and ED diagnoses. The patient's age, race, and marital status were not associated with having an ED UTI diagnosis with a urine culture ≥10,000 colony forming units (CFUs)/mL (vs. <10,000 CFUs/mL). Patient race and the sex of the ED provider were not associated with differences in empiric antibiotic treatment for gonorrhea and chlamydia during the ED encounter. Patient's race and the sex of the ED provider were also not associated with discordance between empiric antibiotic therapy given in the ED and the results of gonorrhea and chlamydia tests that resulted following the ED encounter. In our multivariate analyses, we did not observe that the patient's race resulted in significant differences in the diagnosis of UTIs with bacteriuria ≥10,000 CFU/mL or differences in the empiric treatment of gonorrhea and chlamydia infections among those tested for the infection in the ED. The patient's age and marital status, but not the provider's sex, were significantly associated with differences in the management of gonorrhea and chlamydia.

Evaluation of Genitourinary Infection in Preterm Labour: A Descriptive Cross-Sectional Study

Introduction: Preterm labour is defined as the occurrence of regular uterine contractions (≥ 4 in 20 minutes or ≥ 8 in 1 hour) and cervical changes (effacement ≥ 80% and dilatation ≥ 1cm) in women with intact fetal membrane and gestational age less than 37 weeks. Genitourinary infection is the most important cause of preterm labour. The aim of this study was to determine the role of Genitourinary infection in causation of preterm labour. Methods: This is a descriptive cross sectional study done at National Medical College Teaching Hospital from 10 November 2021 to 9 November 2022 after obtaining IRC (F-NMC/549/078-79). Total of 90 patients in preterm labour fulfilling the inclusion criteria were enrolled in this study after taking informed consent. Clinical examination was done, vaginal swab, endocervical swab and urine samples were sent to microbiological department for examination. Preformed proforma were used to record the demographic, clinical finding and result of investigation. The data was analyzed statistically using SPSS 22 and mean age, frequency and prevalence of genitourinary infection were calculated. Results: In this study, 90 patients of preterm labour were enrolled. The mean age group of patients was 23.61 ± 4.25 years. Genital infection compromised of 41%, high vaginal swab showed 30% prevalence and endocervical swab showed 20% prevalence. The most common organism identified in genital infection was Gardenella vaginalis 55.55%. The prevalence of Urinary tract infection was 40% where E.coli was the most common organism 66.66%. Conclusions: Genitourinary tract infection plays an important role in causation of preterm labour and can easily be diagnosed with routine urine examination, urine culture and vagino-cervical swab. The prevalence of genital infections and urinary tract infection was 41% and 40% respectively. Gardnerella vaginalis was the most common pathogen identified in genital tract whereas E.coli was leading cause of UTI in Preterm labour patients.

P-024 Effect of microsurgical varicocelectomy on fertility potential in patients with low sperm vitality

Abstract Study question Does microsurgical varicocelectomy improve semen parameters and fertility potential in patients with low sperm vitality? Summary answer Micro surgical varicocelectomy in patients with low sperm vitality is beneficial as it results in significant improvement in sperm count and progressive motility. What is known already Low sperm vitality (Necrozoospermia) indicates the presence of higher percentage of necrotic/ dead sperm in the ejaculate which can impair fertility potential. Varicocele induced testicular hyperthermia is among the most common causes of impaired semen quality, including necrozoosprmia. While many studies confirmed the beneficial effect of varicocelectomy on different semen parameters, very few have evaluated its role on sperm vitality in particular. Study design, size, duration A retrospective study of 1521 patients who underwent microsurgical sub inguinal varicocelectomy in our center from 2011–2021. A total of 115 patients with clinical varicocele and low sperm vitality (&amp;lt;58%) were included. Participants/materials, setting, methods The exclusion criteria were history of genitourinary tract infection, exposure to heat, drugs or toxic compounds, hormonal disturbances or prior infertility related treatments. Patients demographics, and clinical data were collected, in addition to the pre- and post-operative Semen analysis (WHO 5th edition), sperm DNA fragmentation (Halosperm) and hormonal profile (estradiol, FSH, LH, Prolactin, Testosterone). Spearman’s correlations and Wilcoxon Signed Ranked Test were used for data analysis. Main results and the role of chance Mean age was 34.9±7.6 years. Varicocelectomy was done on left side in 75 patients and bilateral in 40 patients. Sperm vitality was significantly negatively correlated with sperm DNA fragmentation (-0.618, p = 0.000) and abnormal sperm morphology (-0.435, p = 0.000, while it was significantly positively correlated with total motility (0.674, p = 0.000) &amp; progressive motility (0.272, p = 0.003). The median (IQR) sperm vitality pre-operatively was 41% (30-50) and the level increased post-operatively to 54% (31-63). There was a significant improvement in post-operative sperm count, progressive motility as well as LH and FSH levels. Improvements were also noted in total motility, normal morphology and sperm DNA fragmentation however the result didn’t reach statistical significance. Limitations, reasons for caution The main limitation is the retrospective design of the study and it did not evaluate the pregnancy outcomes. Wider implications of the findings Improvement in semen parameters by microsurgical varicocelectomy in patients with low sperm vitality is important as it may change the management plan for patients and extend their fertility options to natural conception or intrauterine insemination instead of only intracytoplasmic sperm injection. Trial registration number not applicable

Microbiological Analysis of Semen Samples in Male Partners of Couples Attending a Fertility Clinic in a Tertiary Care Hospital, Jaipur

ABSTRACT Background: The natural capability to produce offspring is termed as fertility. As the growing world is flourishing with modern means and advances in technology, there is a sharp fall in the birth rate all over. Many developing countries including India are now struggling with this issue. Bacterial infection of the male genitourinary tract is one of the key factors responsible for male infertility. These pathogenic bacteria induce an alteration in semen parameters, such as sperm count, morphology, and motility which are predictors of male fertility potential. Material and Methods: This is a retrospective descriptive observational study and includes culture reports of 388 semen samples of adult men attending the infertility clinics over a 3-year study period. Sample inoculation was done on culture media plates and incubated for 18–24 h at 37°C. Culture identification and antibiotic susceptibility testing were done using VITEK 2-automated system. Result: Eighty-one samples showed growth of single isolate and were further processed. The majority of the patients were 26–30 years of age, followed by 31–35 years. Gram-positive isolates outnumbered the gram-negative isolates (58% vs. 42.0%). The antimicrobial susceptibility pattern of gram-negative isolates showed maximum resistance against third-generation cephalosporins (70.6%), followed by cotrimoxazole (54.5%) and flouroquinolones (50.0%). Amongst gram-positive isolates, high degree of resistance was observed against tetracycline (89.4%) and fluoroquinolones (72.3%). Conclusion: Urogenital infections in males have been found to be associated with a reduction in fertility. Though these patients may be completely asymptomatic, these infections are known to reduce the sperm counts and motility. Proper bacteriological profiling of these patients is thus an important part of diagnostic workup.

Problems in diagnosing and treating children – victims of sexual abuse, including legal aspects

Abstract Introduction. The most frequent source of information on sexual violence are the victims. It should be borne in mind that children rarely disclose sexual abuse directly, and the symptoms depend on how long they have been sexually abused, the relationship with the perpetrator, the kind of sexual activities, and factors related to the child’s development. The obvious consequences of child sexual abuse are body injuries: genitourinary tract infections and injuries to the external genitalia. Notwithstanding, the psychological consequences are more serious than the physical injuries. Aim. The study aimed to present the problem of sexually abused children including diagnostics and therapy of victims of violence. Conclusions. The effects of sexual abuse of a child include, in addition to physical trauma, also the disruption of proper psychosexual development. The task of doctors, nursing staff , educators, and psychologists is to efficiently and confidently identify the crime, enabling the initiation of therapeutic activities and legal proceedings.

Sodium-Glucose Co-Transporter 2 Inhibitors in Heart Failure-Current Evidence in Special Populations.

Sodium-glucose co-transporter 2 (SGLT2) inhibitors, originally used for diabetes mellitus, are gaining more popularity for other indications, owing to their positive cardiovascular and renal effects. SGLT2 inhibitors reduce heart failure (HF) hospitalization and improve cardiovascular outcomes in patients with type 2 diabetes. Later, SGLT2 inhibitors were evaluated in patients with HF with reduced ejection fraction (HFREF) and had beneficial effects independent of the presence of diabetes. Recently, reductions in cardiovascular outcomes were also observed in patients with HF with preserved ejection fraction (HFPEF). SGLT2 inhibitors also reduced renal outcomes in patients with chronic kidney disease. Overall, these drugs have an excellent safety profile with a negligible risk of genitourinary tract infections and ketoacidosis. In this review, we discuss the current data on SGLT2 inhibitors in special populations, including patients with acute myocardial infarction, acute HF, right ventricular (RV) failure, left ventricular assist device (LVAD), and type 1 diabetes. We also discuss the potential mechanisms behind the cardiovascular benefits of these medications.

(273) A Tight Tuck – More Than Meets the Eyes

Abstract Introduction Tucking is a common practice within the transwomen community. One study estimates that 70% of transwomen engage in this non-surgical gender affirming technique. It entails placement of the testes superiorly towards the inguinal canal and the penis inferiorly towards the rectum to conceal a male phenotype and create a female silhouette. By prolonged distortion of the normal anatomical lie of the penis and testes, several genitourinary complications should be expected to result including low sperm quality, genital pain, genitourinary tract infections, lower urinary tract symptoms, and testicular torsion. However, no formal review or survey has been conducted to better inform physicians on how to appropriately incorporate the practice of tucking into formation of a differential diagnoses. Objective To assess common genitourinary complications and complaints associated with the practice of tucking. Methods We performed a content analysis of posts on Reddit related to tucking and health complaints related to the practice. Reddit is an online forum with various sub-communities known as “subreddits” where anonymous users post and have discussions about a shared interest. In fact, there exist specific forums for the transgender community including r/asktrangender and r/MtF with 142,000 and 161,000 members respectively. A short survey was then created based on common themes of our analysis and posted to the 3 subreddits related to the transgender community with the most members. Results Content analysis first demonstrated distrust and displeasure in physicians’ understanding of genitourinary implications of tucking. Whether this reaction is well founded or not, it is true that there is little understanding within the medical community in this area with many physicians likely ignorant to the degree of anatomical distortion tucking entails. Analysis of common complaints revealed themes similar to those expected from review of what literature has been performed. We expect survey results to support our analysis. Conclusions Formal study is indicated of the genitourinary complications of tucking for physicians to adequately serve our transfemale patients. Disclosure No

Abstract #1368667: Effects of Sodium-Glucose Co-transporter 2 Inhibitors on Adipokines and Inflammatory Markers in People Living with Type 2 Diabetic Mellitus

Type 2 diabetes mellitus is a chronic metabolic disease associated with high cardiovascular disease (CVD) risks. SGLT-2 inhibitors reduce HbA1c and show favorable effects on body weight, blood pressure, lipid profile, arterial stiffness, and endothelial function. More importantly, SGLT-2 inhibitors have demonstrated impressive cardioprotective and renoprotective effects. The main mechanisms of cardioprotective effects have been attributed to improvement in cardiac cell metabolism, improvement in ventricular loading conditions, inhibition of the Na+/H+ exchanger in myocardial cells, alteration in adipokines and cytokines production. This research aimed to observe the effects of SGLT-2 inhibitors on select inflammatory biomarkers, adiponectin, chosen metabolic and anthropometric variables. Compare changes of serum adiponectin between baseline with 16-week after SGLT-2 inhibitors therapy and other variables such as BMI, fasting plasma glucose, HbA1c, for instance, among people with type 2 diabetic mellitus. At 16-week after SGLT-2 inhibitors treatment, a striking increment in mean serum adiponectin by 1.25 mcg/mL (95% CI: 0.02, 2.48) or 81% was revealed. Furthermore, they showed a reduction of mean BMI 1.12 % (95% CI: -1.74%, -0.50%), systolic blood pressure 1 mmHg (95% CI: -1.85, -0.72), diastolic blood pressure 1 mmHg (95% CI: -1.65, -0.52), fasting plasma glucose 34 mg/dL (95% CI: -51.66, -17.10), and HbA1c 0.73% (95% CI: -1.25%, -0.21%). No between-group differences were expressed with the other biomarkers. Serious side effects such as ketoacidosis, hypoglycemic status, genitourinary tract infection, or acute kidney injury were not appeared. SGLT-2 inhibitors can improve changes in serum adiponectin which appreciatively benefit in cardiovascular outcomes among type 2 diabetes.

Drug utilization study of urinary tract infections in obstetrics and gynecology department

Background: The aim of study was to determine the utilization pattern of antimicrobial agents in obstetrics and gynaecology department. Antimicrobial agents are one of the most commonly used drugs word wide and has main contribution in human health system. UTI infection is one of the most widespread bacterial infections of genitourinary tract which can be treated by AMAs. The main aim of this study is; to identify the pattern of drug utilisation of antimicrobials in prescriptions, to analyse the utilisation of different classes of drugs and to identify the outcome of the treatment. Methods: This prospective, observational and analytical study was conducted in patients of obstetrics and gynaecology department of MMIMSR, Mullana after obtaining approval from institutional ethical committee. Demographic data, medical history, prescribed treatment details (drug name, dose, frequency, dosage form etc) and diagnosis, type of UTI, laboratory investigations and outcome of treatment was evaluated. Results: A total 242 female patients were registered, out of which 200 were included in the study as 42 were dropouts. Majority of female patients were belonging to the age group of 18-37 (63%). Most of the female patients had uncomplicated UTI 188 (94%) (p value=0.35), 186 (93%) had significant pyuria and 64 (32%) had urine culture positive (p value= 0.01). Burning micturation and frequency were the most common symptoms observed in 146 (73%). In the study 67(33.5%) females were pregnant and 133 (66.5%) were non pregnant (p value= 0.01). Out of 200 patients 64 (32%) had positive urine cultures and 136 (68%) had negative urine culture reports. E. coli 28 (14%) was the most common bacteria isolated followed by Klebsiella 16 (8%). Average number of drugs prescribed per prescription to non-pregnant was 3.97 and to pregnant were 4.67. In majority of prescriptions, the drugs were prescribed by oral routes (51%) and most of the drugs prescribed were generic (57%). Most of the patients (93%) were recovered from UTIs in 5-7 days of treatment. Conclusions: Our study concluded that the uses of AMAs for UTI were found to be rational and according to the causative organism and susceptibility pattern.

Burden of genitourinary tract and parasitic infections in pregnancy in rural Ethiopia

Burden of genitourinary tract and parasitic infections in pregnancy in rural Ethiopia

Adverse Effects of Denosumab in Kidney Transplant Recipients: A 20-Year Retrospective Single-Center Observation Study in Central Taiwan

Bone loss can be noted in kidney transplantation recipients (KTRs) and can be related to fracture events. Denosumab, a potent monoclonal antibody to RANK ligand, increases lumbar bone mineral density. However, safety data for denosumab remain limited regarding transplant recipients. Hypocalcemia and increased genital tract infections have been mentioned as adverse effects in KTRs after being prescribed denosumab. We retrospectively analyzed the electronic medical records of KTRs during the recent 20 years who had been prescribed antiresorptive therapy and were >18 years old. Medical records and their clinical data were reviewed and analyzed. We compared the frequency of adverse effects between denosumab with other antiresorptive therapies. A total of 70 KTRs were enrolled, with 46 patients being given denosumab and the first injection being noted on October 31, 2014. No significant differences were seen in mortality rate, opportunistic infection, pneumonia, or genitourinary tract infection. One diagnosis of osteonecrosis of the jaw was noted in the denosumab group (2.2%). A higher incidence of hypocalcemia (<8.4 mg/dL) was noted in the denosumab group (34.8%), and a higher but nonsignificant difference in the incidence of severe hypocalcemia was also noted in the group. Denosumab may be considered as safe as other antiresorptive therapies for KTRs. However, more hypocalcemia events have been noted, so medical personnel may need to be cautious when prescribing its use.

The Association Between PCSK9 Inhibitor Use and Sepsis: A Systematic Review and Meta-Analysis of 20 Double-Blind, Randomized, Placebo-Controlled Trials

ObjectiveThe aim of this study was to determine the impact of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor use on incident sepsis and other severe infections. MethodsWe searched PubMed, EMBASE, CENTRAL, and ClinicalTrial.gov up to September 14, 2021, for double-blind, placebo-controlled randomized trials of alirocumab, evolocumab, or inclisiran with >100 participants in each arm and report of serious adverse events related to infection. Data were synthesized with the fixed-effect Mantel-Haenszel model to generate risk ratios (RRs) with 95% confidence intervals (CIs) of each outcome for PCSK9 inhibitor versus placebo. Main outcome was sepsis. Other outcomes were total severe infections, severe bacterial and viral infections, and severe organ system-specific infections including respiratory tract, gastrointestinal, and genitourinary tract infections. ResultsA total of 20 studies of 64,984 participants were included (alirocumab: n = 7; evolocumab: n = 9; inclisiran: n = 4). Sepsis was reported in 292 (0.51%) participants from 11 trials (PCSK9 inhibitor 0.47%; placebo 0.56%). PCSK9 inhibitor use was not associated with risk of sepsis compared with placebo (Summary RR: 0.85, 95% CI: 0.67-1.07, P = .16); nor was it associated with any severe infection (0.96, 95% CI: 0.89-1.03), severe bacterial (0.96, 95% CI: 0.81-1.14) and viral infections (1.01, 95% CI: 0.77-1.33); nor with any severe organ system-specific infection (all P values >.05). The between-study heterogeneity in all analyses was small. ConclusionThere was neither a beneficial nor a harmful association between PCSK9 inhibitors and risk of sepsis or severe infections. These findings provide reassurance regarding the safety of PCSK9 inhibitors in patients who are concerned about potential drug side effects related to infections.

An observational study on dapagliflozin as an add-on therapy in type-2 diabetes mellitus patients in a tertiary care teaching hospital

Background: Diabetes mellitus is one of the prevalent morbid conditions all over the world and no exception for India. Day by day, increase in its prevalence is attributed to lifestyle derangements. To treat this condition many drugs and treatment modalities are developed. Dapagliflozin is an oral antidiabetic drug which acts by sodium-glucose cotransport-2 (SGLT-2) inhibition. Its effectiveness seen in type-2 diabetes mellitus makes it an option for Add-On therapy. Methods: This study is a retrospective observational study conducted at tertiary care hospital, GGH, Kurnool. The study proposal has been reviewed and approved by institutional ethics committee. All adult diabetic patients who were prescribed Dapagliflozin during the period of January 2021 to February 2022, total 45 were included in the study. FBG, HbA1c collected through hospital records from General Medicine and Endocrinology. Patients who stopped drug before 3 months period were excluded. Results: Administration of dapagliflozin as an add-on therapy was found 26.63% decrease in base line mean FBG 184 mg/dl to 135 mg/dl after 3mnoths which is significant (p=0.001). Mean HbA1c significantly reduced by 0.96 percentage point after 3 months (p=0.001). Dapagliflozin effectively reduced the FBG and HbA1c when used in combination with other OHAs or insulin within 3 months. Conclusions: Dapagliflozin as an add-on therapy significantly reduced the HbA1c level and fasting blood glucose of Type-2DM patients, in a 3-month treatment period. Due to the frequency of Genitourinary tract infections, caution is indicated while treating the patients.

Evaluation of Maternal Infection During Pregnancy and Childhood Leukemia Among Offspring in Denmark

Maternal infection is common during pregnancy and is an important potential cause of fetal genetic and immunological abnormalities. Maternal infection has been reported to be associated with childhood leukemia in previous case-control or small cohort studies. To evaluate the association of maternal infection during pregnancy with childhood leukemia among offspring in a large study. This population-based cohort study used data from 7 Danish national registries (including the Danish Medical Birth Register, the Danish National Patient Registry, the Danish National Cancer Registry, and others) for all live births in Denmark between 1978 and 2015. Swedish registry data for all live births between 1988 and 2014 were used to validate the findings for the Danish cohort. Data were analyzed from December 2019 to December 2021. Maternal infection during pregnancy categorized by anatomic locations identified from the Danish National Patient Registry. The primary outcome was any leukemia; secondary outcomes were acute lymphoid leukemia (ALL) and acute myeloid leukemia (AML). Offspring childhood leukemia was identified in the Danish National Cancer Registry. Associations were first assessed in the whole cohort using Cox proportional hazards regression models, adjusted for potential confounders. A sibling analysis was performed to account for unmeasured familial confounding. This study included 2 222 797 children, 51.3% of whom were boys. During the approximately 27 million person-years of follow-up (mean [SD], 12.0 [4.6] years per person), 1307 children were diagnosed with leukemia (ALL, 1050; AML, 165; or other, 92). Children born to mothers with infection during pregnancy had a 35% increased risk of leukemia (adjusted hazard ratio [HR], 1.35 [95% CI, 1.04-1.77]) compared with offspring of mothers without infection. Maternal genital and urinary tract infections were associated with a 142% and 65% increased risk of childhood leukemia, with HRs of 2.42 (95% CI, 1.50-3.92) and 1.65 (95% CI, 1.15-2.36), respectively. No association was observed for respiratory tract, digestive, or other infections. The sibling analysis showed comparable estimates to the whole-cohort analysis. The association patterns for ALL and AML were similar to that for any leukemia. No association was observed for maternal infection and brain tumors, lymphoma, or other childhood cancers. In this cohort study of approximately 2.2 million children, maternal genitourinary tract infection during pregnancy was associated with childhood leukemia among offspring. If confirmed in future studies, our findings may have implications for understanding the etiology and developing preventive measures for childhood leukemia.

Pushing the envelope: Immune mechanism and application landscape of macrophage-activating lipopeptide-2.

Mycoplasma fermentans can cause respiratory diseases, arthritis, genitourinary tract infections, and chronic fatigue syndrome and have been linked to the development of the human immunodeficiency virus. Because mycoplasma lacks a cell wall, its outer membrane lipoproteins are one of the main factors that induce inflammation in the organism and contribute to disease development. Macrophage-activating lipopeptide-2 (MALP-2) modulates the inflammatory response of monocytes/macrophages in a bidirectional fashion, indirectly enhances the cytotoxicity of NK cells, promotes oxidative bursts in neutrophils, upregulates surface markers on lymphocytes, enhances antigen presentation on dendritic cells and induces immune inflammatory responses in sebocytes and mesenchymal cells. MALP-2 is a promising vaccine adjuvant for this application. It also promotes vascular healing and regeneration, accelerates wound and bone healing, suppresses tumors and metastasis, and reduces lung infections and inflammation. MALP-2 has a simple structure, is easy to synthesize, and has promising prospects for clinical application. Therefore, this paper reviews the mechanisms of MALP-2 activation in immune cells, focusing on the application of MALP-2 in animals/humans to provide a basis for the study of pathogenesis in Mycoplasma fermentans and the translation of MALP-2 into clinical applications.

Protective effect of crop by-products on Lactobacillus gasseri H87 during freeze-drying and storage

Appropriate cryoprotectants are critical components of effective probiotic preparations. Beneficial lactic acid bacteria can prevent or treat genitourinary tract infections. Here, we aimed to determine a suitable cryoprotectant combined with crop by-products to ensure the viability and pathogen suppression activity of Lactobacillus gasseri H87 for vaginal capsules that can help maintain the balance of vaginal microecology. Among the five selected cryoprotectants, 15% skim milk (SM) makes L. gasseri H87 survival rate of reaches 56.5%, effectively guaranteeing maximum bacteriocin production by minimizing bacterial cell damage. On the basis of 15% SM, further addition of 1% pomegranate peel extract (PPE) optimized the production of bacteriocin, resulting in the best bacteriostatic effect. After six months of lyophilized storage, L. gasseri H87 from vaginal capsules preserved with 15% SM + 1% PPE had an inhibitory zone of 16.45 mm against the indicator strain Lactobacillus iners. Both lyophilization and storage reduced the adhesion of L. gasseri H87, but the first subculture after 6 months fully restored adhesion under all conditions. These results suggest that skim milk combined with PPE can serve as a suitable cryoprotectant. Lyophilized L. gasseri H87 vaginal capsules have the potential for use in the pharmaceutical industry.

Knowledge and Practice on Menstrual Hygiene among Urban Adolescent Girls in Bangladesh

Introduction: Menstruation-related poor knowledge and understanding among adolescent girls may lead to unsafe personal health care practice that ultimately increases the risk of genito-urinary tract infections, drop-out from school, poor academic performance, and overall poor quality of life. Being a developing country, it is an unrecognized problematic area in Bangladesh. Therefore, it is crucial to assess knowledge and practice on menstrual hygiene among urban adolescent girls in Bangladesh.&#x0D; Methods: This was a community-based cross-sectional study conducted in the Department of Community Medicine of Rajshahi Medical College among 495 purposively selected urban adolescent girls. Data were collected using a semi-structured interviewer-administered questionnaire.&#x0D; Results: The majority (57.2%) of the respondents in the study were more than 15 years old, and most (93.3%) were Muslim. Most of the girls (82.5%) have experienced menarche within the age range of 12-15 years, and the majority of respondents, 259 (52.32%), were informed about menstruation before menarche. Their source of information about menarche was mothers in most cases. Out of 495 adolescent girls who participated in this study, 70.9% had good knowledge of menstruation. About 82% of girls used commercially made sanitary pads, and 35.2% changed pads or clothes more than three times a day during menstruation.&#x0D; Conclusion: The majority (70.9%) of adolescent girls had good knowledge of menstruation, and 73.3% had a good practice on menstrual hygiene. Therefore, there is a need to design and implement universal awareness creation and advocacy programs to improve their knowledge of safe and healthy menstruation management and promote good hygienic practices by creating an appropriate supportive home and social environment for all the adolescent girls.&#x0D; TAJ 2022; 35: No-2: 01-11